Purpose of the Bill

The purpose of this bill is to modify the case mix reimbursement system for nursing facilities in Minnesota to ensure conformity with federal guidelines. This involves changes to existing assessment procedures and reimbursement classifications to align with standards set by the Centers for Medicare and Medicaid Services (CMS).

Main Provisions

• Definitions and Terms Update: Updates definitions and terms used in the case mix reimbursement process. This includes clarifying the 'Assessment Reference Date (ARD)' and introducing the 'Patient Driven Payment Model (PDPM)' for classifying resident needs starting October 1, 2025.

• Resident Classification System: Resident case mix reimbursement classifications will be based on CMS-mandated Minimum Data Set (MDS) assessments. This ensures that nursing facilities use a consistent and updated assessment tool for reimbursements.

• Assessment Schedules: Establishes specific schedules for different types of assessments required by the Omnibus Budget Reconciliation Act of 1987 (OBRA), setting deadlines and conditions for when comprehensive and quarterly assessments should be completed.

• Optional State Assessment: Requires an optional state assessment for certain conditions such as ending therapies or infectious disease isolation to ensure proper reimbursement classification.

• Notification and Audits: Mandates that nursing facilities notify residents or their representatives about changes in their reimbursement classification and outlines procedures for auditing the accuracy of resident assessments including criteria for conducting special audits.

Significant Changes to Existing Law

• Implementation of PDPM: Transition from 'Resource Utilization Groups (RUG)' to 'Patient Driven Payment Model (PDPM)' for case mix classifications on or after October 1, 2025, aligning with new federal standards.

• Revised Audit Procedures: Introduces more stringent audit procedures, including unannounced audits, and allows for expanded audits if there are significant discrepancies in assessment classifications.

• New Assessment Rules for Isolation Cases: Adds a requirement for a significant change in status assessments to be conducted once a resident’s isolation for infectious disease ends, effectively modifying existing protocols for handling resident status changes.

Relevant Terms

• Case mix reimbursement
• Minimum Data Set (MDS)
• Patient Driven Payment Model (PDPM)
• Resource Utilization Groups (RUG)
• Omnibus Budget Reconciliation Act (OBRA)
• Nursing facility level of care
• Audit procedures
• Reimbursement classification